VIDEOLAPAROSCOPIC DIAGNOSIS OF PERITONITIS IN PATIENTS OF OLD AGE

Background: In patients of old age, diagnosis and treatment of peritonitis is more complex due to age-related changes in the organism, the presence of multiple concomitant pathologies.

The aim of the study: To assess the capabilities of videolaparoscopy in the diagnosis and treatment of peritonitis in patients of old age.

Materials and methods: The study includes 64 observations with peritonitis at the age of 75 and above. The causes of peritonitis include: thrombosis of mesenteric vessels - 12 (18.7%); perforated gastroduodenal ulcers - 28 (43.7%), acute appendicitis - 5 (7.8%), acute cholecystitis, 8 (12.5%), acute destructive pancreatitis-7 (10.9% ); perforation of degrading colonic tumors -2 (3.1%), perforation of the sigmoid colon diverticulum - 2 (3.1%), perforation of a small intestine by a fish bone - 1 (1.5%). In all cases, the syndrome of systemic inflammatory response of the organism was not expressed and, therefore, there were given indications for videolaparoscopy. It was carried by a common method under local anesthesia + neuroleptanalgesia.

Results and their discussions: Videolaparoscopic signs of peritonitis were diagnosed in 61 (95.3%) patients. In three (4.6%) cases, the diagnosis was not set videolaparoscopically. Given the stable clinical endotoxemia, they were performed laparotomy. In one case there was observed thrombosis of mesenterial vessels with enteric necrosis, in one - destructive retroperitonial appendicitis and in one - perforation of the sigmoid colon diverticulum. In 10 (15.6%) observations under videolaparoscopic control there was performed cholecystostomy from a mini- access and directed drainage of the abdominal cavity, and in 5 (7.8%) cases of pancreatitis-directed drainage of the abdominal cavity. Laparotomy, the elimination of the source of peritonitis, lavage and drainage of the abdominal cavity was performed in 54 (84.3%) patients. 3 patients died. Postoperative mortality constituted 4.6%.

Conclusion: Execution of videolaparoscopy in cases of obliterated course of purulent-inflammatory process in the abdominal cavity which often occurs in elderly patients, makes it possible to set more concrete diagnosis and perform therapeutic measures, which in some cases may be final.